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Cardiovascular > Pathophysiology of CV Disease > Flashcards

Pathophysiology of CV Disease Flashcards

0
Q

Define heart failure

A

a complex syndrome initiated by an inability of the heart to maintain normal CO at normal filling pressure - as a consequence of heart disease
- BUT not all heart disease will go on to heart failure

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1
Q

Which species is most commonly affected by heart disease?

A

Dogs, cats less comon

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2
Q

What are the 3 types of heart failure?

A
  1. Forward failure
    - inadequate output at normal pressures (eg. syncope)
  2. Backward or congestive failure
    - adequate output at abnormal pressures
  3. Forward and backward failure
    - inadequate output at abnormal pressures (bad)
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3
Q

5 reasons for heart failure?

A
  1. Pump failure
  2. Volume overload
  3. Pressure overload
  4. Arrhythmias
  5. Diastolic heart failure
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4
Q

Is it easy to ID the cause of heart failure?

A
  • no

- final common pathway irrespective of cause (mostly)

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5
Q

What is the final pathophysiology leading to heart failuer?

A
  • real or perceived underfilling of the arterial circulation
    initiates a cascade of events leading to heart failure
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6
Q

What diseases cause 1* failure of myocardial systole?

A
  • dilated cardiomyopathy

- coronary vascular disease (inadequate blood supply to area of the myocardium eg. infarct)

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7
Q

Which diseases cause heart failure by volume overload?

A
  • valvular insufficiencies (mitral, arotic)
  • shunting diseases (ventricular septal defect, patent ductus arteriosus)
  • chronic anaemia
    > all cause the cardiac chamber to chronically increase output -> overwork and eventually heart failure
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8
Q

What is the total stroke volume made up of in mitral valve insufficiency?

A

Forward stroke volume + regurgitant stroke volume

  • forward stroke volume is regulated to maintain arterial filling
  • sometimes regurgitant stroke volume is = or ^ than forward stroke volume
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9
Q

What is the comonest heart disease of dogs?

A

Acquired mitral valve regurgitation/insufficiency

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10
Q

Which diseases cause failure by pressure overload?

A
  • Hypertension - systemic or pulmonary

- Narrowing of the outflow tract - aortic or pulmonic stenosis

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11
Q

Which species gets hypertensive disease?

A

Cats

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12
Q

How may arrythmias cause heart failure?

A
  • low heart rates => v CO

- high heat rates => v SV -> v CO (diastole too short to allow adequate filling)

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13
Q

Which diseases cause failure by diastolic failure?

A
  • Hypertrophic cardiomyopathy
  • Dilated cardiomyopathy (myocardial fibrosis) - stiff ventricle difficult to fill
  • pericardial effusion
    > greater than normal filing pressures needed to maintain CO
    > common in cats
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14
Q

Are most causes of heart failure treatable?

A

No untreatable and irreversible

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15
Q

Average survival for cats with heart failure?

A

< 1 year

16
Q

Which systems in the body ^ circulating volume?

A
  • RAAS
  • ADH
  • Renal autoregulation of flow
17
Q

WHich systems in the body v circulating volume?

A
  • Natriuretic peptides

- Renal autoregulation of flow

18
Q

How is the initial response to cardiac disease described? How does this change over time?

A
  • Adaptive
  • Maladaptive
  • Failure
    > due to chronic stimulation which is not normal
19
Q

What senses a drop in arterial perfusion? What effect does this have?

A 
> CO -> v arterial blood pressure
> Baroreceptors 
- v parasympathetic
- ^ sympathetic activity (b) rate and force
- (a) blood vessels -> constrction
- (b) renin(RAAS) system activated 
> a and b receptor mediated
20
Q

What are the effects of barorecepotrs reflex?

A 
\+ chronotrope
\+ inotrope
\+ luisitrope (relaxation) 
- vasoconstriction
- RAAS
21
Q

What trend is seen in t heHR in mitral valve insufficiency?

A

^ HR over time before deat h (chronic symp activation)

22
Q

Whaen is RAAS activated? What system is acticated next?

A

Underperfusion of kidneys

- ADH activated next

23
Q

Which system countacts RAAS and ADH?

A

Natriuretic peptide system

  • if volume too great detected by myocardium
  • ^ urine output
24
Q

How is the netriuretic systme affected by heart disease? -

A

Volume overload too great

  • high cirulating natriuretic levels
  • but still not great enough to get rid of excess volume
25
Q

What does long term RAAS activation cause? How may this be treated clinically?

A
  • excessive fluid retention
  • excessive resistance to ventricular emptying
  • direct and indirect deleterious effects of myocardium
    > antagonise RAAS in canine and human heart failure
26
Q

Which substances are responsible for local vaso constriction/dilation?

A
  • NO
  • PGs
  • ENdothelin
27
Q

What is the final product of RAAS?

A

Angiotensin 2

28
Q

What system is activated for profound, severe hypotension? What is this normally responsible for?

A

ADH

- retention of free water without sodium (i think?? CHECK)

29
Q

What substances can be used as biomarkers of heart failure?

A

Natriuretic peptides

- ^ circulating volumes

30
Q

What ultimately happens to the myocardium with chronic pressure or volume alterations?

A 
> Remodelling or hypertrophy 
- Adrenergic stimuli 
- Angiotensin II
- Aldosterone
- Intracellular calcium 
> type of loading affects how the heart adapts
31
Q

What causes concentric and eccentric hypertrophy?

A

> concentric
- pressure overload (hypertension, aortic stenosis, weights)
eccentric
- volume overload (mitral regurgitation, shunting disease, marathons)

33
Q

What does chronic hypertrophy cause?

A
  • ^ oxygen demand
  • hypoxia
  • fibrosis
34
Q

In what order do the characteristic effects of heart failure occour?

A
  • Short term: alteration in autonomic tone
  • Mid-erm: stimulation of endocrine systems
  • Long term: Hypertrophy
35
Q

What are some of the clinical signs of heart failure?

A
  • tachycardia
  • poor peripheral perfusion
  • fluid retention (RAAS and ADH)
    > LCHF: ^ pressure in the left side and pulmonary oedema
    > RCHF: ^ filling pressure in right side and oedema from systemic veins (abdo etc.)
36
Q

What is thromboembolism?

A

Blood clot breaking off and occluding a vessel

37
Q

Which diseases causes thromboembolism?

A
  • cardiac disease
  • cushing’s disease (hyperadrenocorticism) - parasitic disease
  • Protein losign nephropathy
  • Neoplasia
  • Auto-immune haemolytic anaemia

Cardiovascular (11 decks)

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